why should we care?medigogy.com/sites/default/files/attachments/tcm male fertility... · main...

11/17/2010

1

Integrative TCM for Male FertilityIntegrative TCM for Male Fertility

The Treatment of Male Infertility:

An Integrative CM Approach

Integrative TCM for Male Fertility

Why Should We Care?

• Infertility diagnosis– 40% male factor

– 40% female factor

– 20% no explanation

• 60% of the time, the male is or may be the issue

• Diagnostics for male are not absolute for fertility purposes:– Semen analysis

– Varicocele detection

– Leukocytospermia

11/17/2010

2


Why Should We Care?

• Inability to conceive in heterosexual partners is always a problem of the couple– Emotional factors

– Intimacy factors

– Diet / lifestyle factors

• Classical CM (Sun Si Miao in particular)– Fertility treatment always prepared both male and female for conception

• It is absurd to think that semen quality does not matter for IVF/ICSI– Emerging research is confirming this


Why Should We Care?

• Most conventional fertility clinics are staffed by RE’s trained primarily as gynecologists– No emphasis on urological procedures / anatomy / physiology

– Natural focus on their area of expertise –gynecologcial procedures / anatomy / physiology

• We often end up as “front line” for male patients who are not referred to urologists for mild to moderate fertility issues– Most fertility clinics focus on IUI and/or ICSI as a way to circumvent male issues

– In my clinic I often am first referrer to urologist for complete workup

11/17/2010

3



Volume:

-May ’08: 2.0mL

-May ‘09: 4.0mL

Concentration:

-May ’08: 30 million per mL

-May ‘09: 108 million / mL

Motility:

-May ’08: 30%

-May ‘09: 80%

Morphology:

-May ’08: no measure

-May ‘09: 1.5% (low)

Net result: ~21 million motile

sperm increased to ~300

million motile sperm

Treatment synopsis: Resolve

IBS symptoms, correct poor

dietary habits

11/17/2010

4


Role of Natural Medicine

• Detect and address systemic imbalance

• Do not assume that “normal” tests mean “normal” function

• Provide emotional support and guidance when appropriate

• Address nutritional factors by providing proper supplementation / dietary remodeling

• Educate patients on effects of emotional and cellular stress


Tao

“Those who wish to change the world according with their desirecannot succeed.

“The world is shaped by the Way; It cannot be shaped by the self. Trying to change it, you damage it; Trying to possess it, you lose it.”

- Lao Tzu, Tao Te Ching

11/17/2010

5


Hormones

hormone – (n) A substance, usually a peptide or steroid, produced by one tissue and conveyed by the bloodstream to another to effect physiological activity, such as growth or metabolism.[From Greek hormōn, present participle of hormān, to urge on, from hormē, impulse.]


Doctor

[from Latin: teacher,

from docēre to

teach]“A teacher affects eternity:

he can never tell where his

influence stops.”

Henry Adams

“Nine-tenths of education is

encouragement.”

Anatole France

11/17/2010

6


An Integrative Model of Stress as

Energetic “Dispersal”• Cortisol -> Release of stored energy

– Glycogen in liver is converted to glucose

• Binding proteins are suppressed– Body’s ability to “concentrate” hormones is impaired

– Hormones “disperse” into fluid layer

• Insulin is > in response to > blood sugar– Insulin alters reproductive hormone production

• Blood pressure is increased under influence of HPA axis– More blood to brain, lungs, heart, muscles

– Less blood to reproductive function

• Result is resources moving upward and outward to meet the threat / crisis


Main Aspects of Hormone

Health• Sufficient production

– Nutrient-rich environment

• Ready activation– Non-competition with other hormones, minimal interference from stress

• Efficient usage– Healthy circulation and metabolism

• Proper deactivation– Healthy function of liver

• Proper elimination– Healthy function of liver, colon, kidneys, lymph system, circulatory system

11/17/2010

7


A Little Bit Goes a Long Way

• Hormones measured in micrograms

• Changes in:– Blood sugar metabolism

– Eliminative capacity

– Liver detoxification functions

– Adrenal health

– Body fat composition

• …may have dramatic effects on hormonal status and function


Semen Analysis

• WHO criteria

– VOLUME: >2.0 ML

– pH: 7.2-7.8

– CONCENTRATION: >20x106/ML

– MOTILITY: >50%

– MORPHOLOGY: >30% NORMAL

– WBC: < 1x106/ML

11/17/2010

8


Semen Analysis – NOT a fertility

test

• Up to 30% of males with “normal”

semen analysis may have abnormal

sperm function– Irvine DS. Aitken RJ. Seminal fluid analysis and sperm function testing. Endocrinology

& Metabolism Clinics of North America. 1994;23(4):725-48

• 25% or more of infertile men have high

ROS (not measured on semen analysis)


The Long Journey Home

A sperm begins as a spermatocyte and must complete the following journey to complete its purpose:

1. Mature over a 64 day period (8 cycles of 8 days) into a fully-mature spermatid

2. Traverse several meters through the epididymis to the tail as it continues to mature

3. Survive the densely packed environment of the caudaportion of the epididymis

4. During ejaculation: Traverse the vas deferens and pass through the seminal vesicle and prostate which expose it to various fluids and proteins

5. Exit the urethraAnd this is only the beginning…

11/17/2010

9


Sperm cells

• Did you know?

– A sperm cell is incapable of apoptosis (programmed cell death) because it lacks the mRNA required for this process?

– This means that sperm only die due to external stressors, lack of nourishment, or malformation that affects development.


Estrogen

• “It is beyond doubt that oestrogen is also fundamental to the maintenance of normal male fertility; mouse knockout models with inactivated oestrogenreceptors result in diverse infertilityphenotypes [Couse et al. 1999; Eddy et al.1996; Krege et al. 1998; Robertson et al. 1999; Zhou et al. 2001].” H.G. Tempest et al., Systems Biology in Reproductive Medicine, 54:185–195, 2008

11/17/2010

10


Testosterone

• Necessary to support formation of sperm

• Exogenous testosterone from creams/gels/pills/injections suppresses sperm production

• Decreases with age

• Is directly or indirectly suppressed by many stress-related chemicals (cortisoland prolactin)

• Can be dramatically reduced by excess body fact composition (even mild obesity)


Estrogen – Important Notes

• Men have estrogen and it is important for regulating sperm production

• Estrogen supresses testosterone production• Estrogen is produced peripherally by a process called aromatization– High body fat %age (esp. belly fat) can cause increased estrogen by way of aromatization, this lowers concentration of testosterone and can affect fertility

• Excess estrogen is not always a condition of excess production – it can also result from insufficient elimination

11/17/2010

11


Capacitation

• As sperm are ejaculated, proteins and

other substances in seminal fluid

secreted by seminal vesicle > motility

• Acidity of vaginal secretions further

activates the sperm to make them fully

motile


ROS – Reactive Oxygen Species

• “Oxidative stress has also been implicated in male infertility with significant levels of reactive oxygen species (ROS) detected in 25% of infertile men, however fertile counterparts have no detectable levels of ROS [Iwasaki and Gagnon 1992]. Indeed significantly elevated generation of reactive oxygen species by abnormal spermatozoa and contaminating leukocytes (leukocytospermia) is one of very few defined male infertility aetiologies.” H.G. Tempest et al., Systems Biology in Reproductive Medicine, 54:185–195, 2008

• Evidence has been provided that semen samples from fertile men show an antioxidant capacity greater than their sub-fertile counterparts. H.G. Tempest et al., Systems Biology in Reproductive Medicine, 54:185–195, 2008

11/17/2010

12


ASAb

• Antibodies that attach to sperm

• Promote phagocytosis by immune cells

• NOT autoimmunity– Caused by sperm escaping out of testicular / epididymal / ductal system

– Sperm DNA is NOT identical to host DNA

• Most common causes:– Testicular injury allowing sperm to escape (i.e. sports)– Surgical injury (i.e. hernia repair, vasectomy or reversal)

– Compromise of blood-testis barrier due to obstruction and resultant fluid distension in ductal system


Seminal fluid

• Urethral and bulbourethral glands– 0.1-0.2cc Viscous, clear

• Testes, epididymis, vas deferens– 0.1-0.2cc Sperm present

• Prostate– 0.5-1.0cc Acidic,watery

• Seminal vesicles– 1.0-3.0cc Gelatinous, fructose positive

• Complete ejaculate– 2.0-5.0cc Liquefies in 20-25min

11/17/2010

13


DNA Fragmentation

• “The unsaturated fatty acids are targets for free radical attack and ongoing lipid peroxidation throughout the sperm plasma membrane resulting in the accumulation of lipid peroxides on the sperm surface causing sperm dysfunction and cell death [Aitken and Baker 2006; Sheweita et al. 2005]. Moreover, nuclear and mitochondrial DNA are subject to damage at low levels of oxidative stress; this in turn may lead to pregnancy loss [Aitken and Baker 2006; Lopes et al. 1998].” H.G. Tempest et al., Systems Biology in Reproductive Medicine, 54:185–195, 2008


Adrenal glands

• Produce cortisol which regulates stress

response

• Produce DHEA, Pregnenolone, and

other important precursors for

steroidogenesis

• Important role in regulating sleep,

mood, blood sugar stability, blood

pressure, and other functions

11/17/2010

14


Adrenal functional challenges

• Things that can alter adrenal function

– Chronic, unmanaged stress

– Digestive disturbances

• Membrane dysfunction

• Cellular metabolic challenges

• Confused hormonal signalling

– Lack of rest

– Under or over-exercise


Other Causes of Male Subfertility

• High or low blood pressure

• High or low cholesterol

• Diabetes

• Drug/alcohol abuse, smoking

• Medications (cimetidine, beta-

blockers, others)

11/17/2010

15


The Role of Surgery, IVF/IUI, and

Fertility DrugsWhat they do:1. Attempt to enhance the spermatogenic

process through hyperstimulation of the testes (i.e. Clomid, Gonal-F, hCG)

2. Assist sperm in traversing the cervix and uterus (IUI)

3. Assist the sperm in fertilization of the egg (IVF-ICSI)

4. Correct or circumvent varicocele, tubal blockage, absence of vas deferens, retrograde ejaculation, other types of mechanical blockage


The Role of Surgery and Fertility

DrugsWhat they don’t do:1. Force an undernourished or highly stressed

body to produce better quality sperm2. Bring nutrients and oxygen into the

reproductive tract to support healthy production and maturation of sperm

3. Correct chronic health issues that may be the root cause of the problem

4. Reduce systemic inflammation and nervous system tension to create a harmonious environment for sperm development and capacitation

11/17/2010

16


Self-Diagnosis for Males with

Fertility Issues

• Morning erection

• Frequency of intercourse

• Sleepiness after meals

• Energy in AM

• Hours of sleep/wake

• BM frequency and symptoms

• Blood pressure – high/low/meds


Herbal Compounds

• Ginseng

• Tribulus

• Chrysin

• Genistein

• Flavonoids

• Muira Puama

• Maca Root

11/17/2010

17


Nutrients

• L-Carnitine

• L-Arginine

• CoQ10

• Vit C

• Vit E

• Inositol

• Chromium

• Zinc

• DIM / I3C

• Flavonoids

• Beta Sitosterol


Acupuncture

• Research suggests that acupuncture

may improve:

– Motility of sperm (Dieterle, et al., FertilSteril. 2009 Oct;92(4):1340-3)

– Sperm concentration (Siterman, et al., Asian J Androl. 2009 Mar;11(2):200-8)

– Morphology (Pei, et al., Fertil Steril. 2005 Jul;84(1):141-7)

11/17/2010

18


Lifestyle and Diet

• Reduce or eliminate caffeine

• Avoid overconsumption of sugar and bready foods

• Do not ride a bicycle more than 1 – 2 hours a week

• Avoid hot tubs and saunas

• Keep a regular bedtime and get plenty of rest

• Drink 3 – 4 liters of water daily

why should we care?medigogy.com/sites/default/files/attachments/tcm male fertility... · main...

Documents